Classification

The heterogeneous nature of pediatric feeding disorders makes attempts at classification important. As suggested earlier, simply classifying feeding problems as organic (i.e., those with a clear medical etiology) or nonorganic (i.e., those for which no clear medical cause has been identified or behavioral issues are considered primary) is insufficient and even inappropriate in many cases (Manikam and Perman 2000). According to Manikam and Perman (2000), this dichotomy, which has dominated classification schemes until recently, not only is an oversimplification but may even interfere with optimal management.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association 2000), provides little differentiation among child feeding disorders, grouping heterogeneous feeding problems under the classification of feeding disorder of infancy and early childhood. Perhaps of greater clinical and research utility is the classification system created by Cha-toor et al. (1984, 1997), who included several subclassifications under the broader DSM-IV-TR diagnostic category: 1) feeding disorder of homeostasis, which is characterized by inadequate child food intake related to problems establishing regular and effective feedings; 2) feeding disorder of attachment, which results from poor engagement between care-giver and child, leading to failure to adequately gain weight; and 3) infantile anorexia (feeding disorder of separation), which is characterized by high levels of conflict and infant food refusal. Chatoor et al.

(1997) identified important child and parent symptoms that contribute to each of these disorders, highlighting the relational nature of these feeding problems. Chatoor et al. (2001) also proposed posttraumatic feeding disorder as a diagnostic category for feeding problems characterized by distress and resistance to feeding following a traumatic event (e.g., choking, gagging, force-feeding).

In classifying feeding disorders, one important distinction should be noted. The termsfeeding disorder and failure to thrive are often used interchangeably to describe infants and young children who exhibit impaired growth (Chatoor 2002). However, failure to thrive is a purely descriptive term and may not adequately capture the causes of growth failure, because multiple pathways can lead to growth failure (Gold-bloom 1987). Similarly, failure to thrive may result from multiple etiologies (e.g., oral-motor dysfunction, choking, gastroesophageal reflux); however, as Chatoor (2002) argued, not all feeding disorders lead to growth failure, and not every child with growth failure has a feeding disorder. Ultimately, the use of different nomenclature can have a significant impact on both clinical decisions (e.g., identifying evidence-based treatments for feeding problems) and research (e.g., comparing results across studies).